This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

CIRRHOSIS

Cirrhosis is a chronic disease of the liver that causes inflammation, hardening of liver cells and scarring. The condition restricts blood flow through the liver and damages liver function.

In most cases of cirrhosis, bile ducts (small tubes that help with digestion) become red, and swollen and fill up with pus and bile. The liver tries to form new ducts, but the overgrowth of tissue distorts and shrinks the liver. As a result, nutrients are no longer well absorbed. Toxins remain in the blood which the liver normally removes and processes into harmless forms. Although cirrhosis cannot be completely cured, its course can be slowed by treatment and lifestyle change.

WHAT CAUSES CIRRHOSIS?

In the United States, the main cause of cirrhosis is long-term alcohol consumption. A less frequent cause is viral hepatitis. Rarer causes include reactions to certain drugs, exposure to toxins in the environment and heart failure that leads to liver congestion. Occasionally bile duct defects cause increased liver absorption of iron or copper. In children, cystic fibrosis can sometimes lead to cirrhosis.

WHO GETS IT?

Cirrhosis occurs most often among people aged 40 to 60, but it can occur in children as young as 15. In the U.S. and Europe, over 65% of cirrhosis cases are alcohol-related, and the disease occurs in up to 15% of all alcoholics.

The condition is becoming more common in developing countries where women seem to be more susceptible to it than men. In Africa, and in the Far and Middle East, cirrhosis is often caused by chronic viral hepatitis, especially hepatitis B.

WHAT ARE THE SYMPTOMS?

In early stages, fatigue, weight loss, nausea, liver enlargement and edema (swelling of tissues) may be signs of cirrhosis. Symptoms of later stages include jaundice (yellow color in the skin and eyes), enlargement of the spleen, mental confusion and memory loss. Many cirrhosis patients bruise easily due to a shortage of nutrients in the blood that help clotting. Itching, abdominal pain and loss of sexual energy also may occur.

DIAGNOSING CIRRHOSIS

Often there are no symptoms. The condition may be first detected by routine blood tests or during a physical examination when the doctor notices a change in the size and shape of the liver. In early stages, the liver feels abnormally firm and somewhat enlarged. In later stages, the liver is smaller than normal, and the spleen is enlarged.

If the doctor suspects liver problems, liver function and blood tests will be given. The diagnosis can be confirmed by a liver biopsy in which a small piece of the liver is removed and examined under a microscope. Because the liver is just beneath the skin, the doctor has easy access to it and can take a biopsy through needle suction, under local anesthesia.

TREATMENT OF CIRRHOSIS

Although cirrhosis is not presently curable, measures can be taken to slow its progress and ease some of the symptoms.

The most important step is to stop drinking alcohol to reduce the work of the liver. Medications that are filtered through the liver should also be stopped.

Diuretics, a low-salt diet and potassium supplements can help decrease water retention and move fluids out of the body.

If the disease is in an early stage, your doctor may prescribe a diet high in carbohydrates and protein, with no restrictions on fat intake, but low in salt. If the condition is alcohol-related, multivitamins may be given. If jaundice is present, vitamins K, A, D, and E may be prescribed.

When the condition is advanced, you may be advised to eat a low-protein diet since toxins form in the liver during the breakdown of protein. Laxatives may be suggested to speed the protein through the digestive process, exposing it to less bacteria so that it produces fewer toxins.

Pressure in veins around the liver can be reduced by surgery. A new passage is artificially created to change the direction of blood flow, directing it away from the already full veins.

In cases of chronic viral hepatitis, steroid drugs can prevent the progression of the condition to cirrhosis. Excess amounts of copper and iron in the blood also may be treated. The use of liver transplantation as a treatment for advanced cirrhosis is now in experimental stages.

WHAT YOU CAN DO

If is very important to stop drinking alcohol, and a variety of counseling and therapy programs are available to help you. Alcoholic Anonymous, for example, which is based on peer support, holds frequent free meetings. Tell your doctor if you are taking medications or supplements, including over-the counter medications. Try also to avoid exposure to toxic chemicals, such as solvents.

If you are hospitalized, use the time to learn about the dietary changes you can make in order to slow progression of the cirrhosis. When at home, follow your new dietary restrictions, being careful to eat nutritious meals and go easy on the salt. Get enough exercise and sleep, including midday naps if you feel fatigued during the day. Keep track of your weight and visit your doctor regularly for monitoring, lab work and tests. This way, if complications occur, they can be detected early and you may be treated as an outpatient.

COPING

Learning that you have a chronic illness may be difficult and stressful, both for yourself and for your family and friends. Feelings of depression, anger and guilt are common, but can often be eased by talking with others in similar situations. Support groups exist for people with a wide variety of medical conditions, and it can be of great help to know that other people are going through experiences like your own. Professional counseling also may help, particularly if you are attempting to give up alcohol. Your doctor may be able to refer you to programs and support groups to assist you.

Each individual develops his or her own way of coping with illness. A positive attitude, knowledge of the facts, and patience with yourself can help you accept the limitations and possibilities of your condition.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

Planetree Health Fact Sheets are developed by Planetree, Inc., a non-profit consumer health organization, founded in 1978. The Planetree Alliance includes hospitals and libraries which, among many other patient-centered concepts, promote the importance of access to health information for patients, families, and community. For more information regarding affiliation with the international Planetree Alliance, call (203) 732-1365 or visit Planetree, Inc. at www.planetree.org.